When it comes to determining your health insurance needs, you may wonder if dental insurance is really worth the cost. But before turning down a dental insurance plan offered by an employer or giving up on seeking out a private policy, it is important to know what dental insurance truly does and offers.
What is Dental Insurance?
In the most basic sense, dental insurance is a kind of healthcare insurance that helps with the cost of going to the dentist or having dental work done. Dental insurance is around to help with the high costs of oral examinations, cleanings and procedures you may need which often aren’t covered by other forms of insurance such as Medicare. In some cases, dental insurance can help lower the amount of money you pay out-of-pocket for necessary dental work, such as fillings, or related medical devices such as retainers, dentures or other kinds of false teeth.
Dental insurance is often considered an elective policy, meaning a private employer may give you the option to enroll for an addition premium — meaning that the cost of your dental insurance is not part of the premium you pay for other health insurance policies. Every dental insurance plan varies by location, personal needs and the insurance company offering the policy.
How Dental Insurance Plans Generally Work
The cost of dental insurance and the particulars of what it covers are different from plan to plan. But generally, the goal of dental insurance is to lower the amount you pay for services at a dentist’s office.
In most cases, you will pay a monthly premium for dental coverage. Premiums range in price depending on the kind of plan you select, where you live and from what company you get your benefits. Lifestyle factors such as being married, smoking or drinking can also lower or raise your monthly premium, as insurance companies see these factors as insight to how risky you are to cover. Generally, negative factors such as being a smoker can lead to higher monthly premiums since many insurance companies believe you will require more costly care.
After paying your monthly premium, you will be allowed to use your dental benefits. Dental services fall into one of three categories:
- preventative care
- basic care
- major care
Most dental insurance plans give you a guideline of what kinds of services you can receive and how many times per year. It is not uncommon for your dental plan to fully cover kinds of preventative care, such as one to two annual cleanings and exams, but offer limited coverage for things you need at a dental checkup such as x-rays or oral tests. Insurance companies may also cover all or a portion of basic services you will need at a dentist’s office, such as fillings, root canals and other dental work. How much your dental plan pays for major work, such as crowns, bridges and dentures, also depends on the insurance provider. Each policy differs in how much it will pay for the services, so it is important to know the extent of your dental benefits before you receive any kind of dental work.
Many insurance plans will require you to pay a copayment or reach a deductible before receiving services. Copayments (also called copays) are an upfront cost you pay to a doctor’s office before your examination or service. In some cases, you may have a deductible for more serious oral needs, such as surgery or major tooth work, before insurance will kick in. This means that if you have a $300 dental insurance deductible, you will pay $300 in dental costs before insurance will begin paying for some or all of your care.
After receiving the services you need, your dentist’s office will bill your insurance company for the care you have been given. After your insurance plan pays its allotted amount (often a percentage of the cost as opposed to a flat amount), you will receive a bill from the dentist’s office for any remaining balance. Unfortunately, most kinds of insurance do not fully cover every kind of procedure or examination, so knowing how much to budget for annual care or bigger medical services can ward off the stress of a large bill. With the same thought, understanding your benefits can help you make the most of your healthcare, allowing you to get the best dental care you can afford instead of paying for a policy and not using it.
Types of Dental Insurance Plans
Just like with medical insurance, your dental insurance may have limitations on what dentists you can see. There are several forms of dental plans that offer different benefits.
Preferred Provider Organization plans (PPO): With a PPO dental plan, you can choose from dentists within a network. These “preferred providers” offer insurance companies a lower rate for the dental care you receive, and insurance companies pass the savings onto you in the form of less expensive care. With PPO plans, you often pay for a percentage of the care you need while the insurance company picks up the remainder. Unfortunately, PPO plans require you to choose from a selection of dentists, meaning sticking with a dentist who is not in the network or switches out of the insurance network can be costly.
Health Maintenance Organization plans (HMO): HMO dental plans are often touted as being budget friendly for families. This kind of dental plan often does not have deductibles or maximums, but require you to stick with one dentist’s office for all the oral care you need. For services beyond preventative care, you often pay a copayment based on that specific service. This is helpful at allowing you to know the upfront cost of dental work instead of being billed for it in the end.
Fee-for-Service/Indemnity plans: Fee-for-service plans often give you the widest network of dentists’ offices to choose from. With this kind of dental plan, you pay a percentage of the cost for dental services you receive while your insurance company pays the remainder. Fee-for-service plans are often used when you have a preferred dentist who is not within a particular dental insurance network. In many cases, your insurance provider may put a cap on how much they are willing to pay for your dental services in a given year.
What Dental Insurance May or May Not Cover
Most dental insurance covers preventative care, such as annual cleaning and exams. Services such as fillings and root canals are considered basic care, while more advanced needs such as bridges, crowns and dentures are considered major services. Each insurance company determines how much it will cover for dental care in these three tiers.
Yet, many dental insurance plans do not cover cosmetic procedures. This includes a litany of common services such as teeth whiting or bleaching and tooth shaping, but also goes as far to include adding veneers, straightening teeth, removing gaps or bonding spaces between teeth.
Enrolling in a Dental Insurance Plan
Enrolling in a dental insurance plan does not have to be complicated. Many people are provided dental insurance options through their employer and can choose to opt-in for dental benefits. But in some cases, such as being self-employed or a retiree using Medicare (which does not cover dental work), selecting a dental insurance plan can be more daunting as you balance benefits with budget. To find a plan that fits your needs, consider speaking with PolicyZip’s dental insurance specialists who can guide you in the right direction.